Major Surgery

by Lola Keeley

Trouble is, wishing for surgery as a trauma surgeon technically counts as wishing untold horror on an unsuspecting human body. Even in her worst moods, Cassie wouldn’t want that for anyone. What she sees happen to people who never, ever deserve it, has a shocking and permanent effect on perspective.

  There’s a song stuck in her head as she showers and changes. She splashes out the drumbeats against the tiles, humming where she doesn’t know most of the words. The air, something about the air tonight. Even with her patchy and awful knowledge of pop culture, Cassie knows it’s something that would be classed as an oldie by now, but it puts the spring back in her step at least.

  Then she’s dressed and back on the ward, and the surgical gods are smiling after all, because the tight frenzy in the air says they have a heads up from A&E. The most critical and badly injured cases come in that way from the ambulance. Instead of the sedate admissions process and a couple of hours’ wait, these patients are express delivered to Cassie’s domain.

  It’s not a tent now. She has staff and facilities beyond even her reckoning, new tech that she’s itching to get trained on as well. The more she can do, the more she can help. It’s that simple. The registrars have been summoned from the Sister’s Office, the ward’s unofficial break room, and Sister Pauline isn’t far behind them, her expression all business.

  “What do we have?” Cassie demands, pulling on her plastic apron and tying it hastily at her back. The buzz amongst the staff heightens second by second, all eyes focused on the swing doors that bring fresh meat to their trauma bays.

  “Male, 33, RTC,” the first paramedic announces, wheeling his patient right to her. The acronyms are different, but already Cassie is more than familiar with road-traffic collisions; they’re some of the most frequent fliers on her service. “We’ve stopped most of the visible bleeding, but cracked ribs and uneven breath sounds on the right side.”

  “Let’s get him stable and then…” Cassie makes her visual assessment and realises they have some time to work with. “We’ll need a CAT scan.” She palpates his abdomen. Definitely fluid, but no bruising to indicate that it’s blood. A groan from the patient on inspecting his ribs confirms the impact.

  It’s time to test her team. She has to be able to trust them. They have enough bodies to cope with the incoming patients, and nobody seems panicked or out of their depth.

  “Pauline, I’m taking my patient over to Imaging and probably straight into theatre from there. Make sure a scrub team is ready, but get me back here if anyone’s patient starts to slip, understood? Oh, and page the on-call general surgeon. I’m going to need an extra pair of hands.”

  She feels the worried glances from her doctors and nurses as she departs first, but Cassie knows she has to let them sink or swim. It might be nice, in this manageable number of patients, to focus on just one for a change.

  Nick is her patient, she learns on first glance at the chart. It’s barely filled in, waiting for her to find out exactly what’s wrong.

  She’s busy with that chart as Nick is transferred onto the CT scanner, ready for his internal close-up.

  “I was paged?”

  Great. Veronica Mallick. “Must be a mistake,” Cassie suggests, not looking up from her clipboard. “Got it, thanks.”

  “Well, I am the general surgeon on call this morning.” There’s that haughty tone again.

  Cassie doesn’t feel the same fondness over blouses and a slightly messy locker now. “And this is my patient. Don’t let me keep you—plenty of other injuries out there, Veronica.” It feels cheeky to revert to first names, even though the invitation was extended to.

  “Well, indulge me. What are you looking at with this fine young man? Another RTC?”

  “They come in batches, so I’m told.” Cassie resents explaining, but it can’t hurt to show off her expertise. She checks the screen. “Confirming broken ribs on the right side, and that looks like a small pneumothorax to me, where the third rib is intruding. There’s a liver lac, but nothing too dramatic, and that appears to be some free fluid in the abdomen. Repairs won’t take long.”

  “Repairs? We’re talking about a man in his thirties, not a Volvo.” Veronica reaches for the chart, but Cassie pulls it away.

  “I’ll be in theatre, there should be a team ready by now. Anything else?”

  Veronica looks her up and down for a long few seconds. “No, I don’t suppose there is. Best of luck, Ms Taylor.”

  “Thank you,” Cassie replies, quite insincerely. She motions for the orderly and nurse to get their patient back on the move, but just then his monitor starts beeping.

  Cassie charges straight through from the observation area, but Veronica beats her to it. Usually a nurse would be on hand with a crash cart, but Veronica goes straight to it, confidently yanking it across to their patient’s side.

  “He’s unresponsive,” Cassie says, a brisk warning. This is her field of expertise.

  “He’s in respiratory arrest,” Veronica says by way of clarification. “I’m intubating, now.”

  “Now, isn’t this the point where you’d usually say procedure calls for an anaesthetist?”

  “So you do know the protocols.” Veronica sounds a little peeved, but the look she shoots at Cassie is almost…teasing. “Thank you,” she says to Ana, the nurse who’s stepped up to hand over the laryngoscope.

  Cassie is itching to get in there and take over, but from the cursory inspection, Veronica is tutting under her breath.

  “Okay, blood and swelling here. I can’t see the glottis, so we can’t go in this way.”

  “Now, wait a minute—” Cassie tries to interrupt. If they’re talking about emergency airways already, this really is her area.

  Veronica is having none of it. “Get that bag ready. We’re going to need a surgical airway. Size 7Q, and a cricothyrotomy kit, please.”

  By the time she makes the incision in Nick’s throat, Cassie is reduced to standing a safe distance from her elbow, ready with the bag that will squeeze air into their patient’s lungs. With the crike incision made, the plastic airway inserted, all that’s left for Cassie to do is attach the bag with minimum fumbling.

  A few steady squeezes later and Nick’s stats start climbing, the portable monitor finally easing back to a steady beep.

  “I’ll take over, Ms Taylor,” Ana says, short blonde hair falling over her face as she leans from the other side of the patient’s gurney.

  Cassie is quick enough to give it up.

  “Thanks for the assist,” Veronica says, and Cassie must be hallucinating because that almost looked like a wink. “We’d really better get to theatre.”

  With that, Veronica stands back and lets their small team leverage the patient back onto the gurney and out into the hall. Small, swift, steady movements. The patient keeps breathing and his portable monitor remains happy.

  That went well, all things considered, but as she follows them down the hall, Cassie has to admit she’s recalibrating her opinion of Veronica Mallick. Underneath all that officiousness there’s a real field doctor, one with good hands and a cool head.

  Cassie just wishes those qualities weren’t some of her very favourites.

  Chapter 7

  The knock on her door is soft, but when Veronica doesn’t answer, it comes again. Persistent bugger, then. Sitting back in her chair, she pulls off her reading glasses with a sigh. Lea almost caught her wearing them last week, and a little bit of vanity persists about the simple fact of weakness in her sight.

  “Sorry to disturb.” Of course. Hurricane Cassie. Turns patient care into some kind of reality show try-out, and lets the overgrown children masquerading as real doctors call her by her first name. Honestly, Veronica would rather she didn’t come visit AMU at all.

  Any two doctors having more than one conversation with each other is gossip fodder for the sex-obsessed junior doctors who view the rest of the h
ospital as their own private soap opera. Although she’s discreetly out at work, Veronica can’t stand being part of the rumour mill. With Cassie being so… Well, Veronica is sure there’s some wonderful new acronym for it all, but she calls it soft butch… It would be putting two and two together to make five.

  “I was just heading out,” Veronica lies smoothly. “Haven’t escaped this bloody desk all day.”

  “In that case, can I buy you a coffee?” Cassie shoves her hands in the pockets of her scrub trousers. Ever since that first day, Veronica is yet to see her in anything but scrubs. Perhaps she misses the army uniforms and is trying to replicate all that sameness. “Only I think I might need to pick someone’s brain, and as my nearest senior colleague…”

  Veronica assents by standing, swiping her handbag from under the desk, and ushering Cassie out of the office before her. They make it halfway down the corridor before a brief commotion and a crash cart distract them, but the staff on duty have it handled.

  “Thought we were going to have a reprisal of our fun day with emergency crikes for a minute,” Cassie says, attempting a joke.

  Veronica just nods in acknowledgment. She watches Peter run the code for a moment, barking orders at everyone around him. He really would have been good in Trauma.

  “So, the brain picking?” Veronica urges when they set off again. One thing she has learned so far is that the bulk of the conversational burden is going to be on her shoulders. “I suppose you’re knee-deep in next year’s budget as well?”

  “Mmm,” Cassie seems to agree. “I don’t mind numbers, I really don’t. It’s everything that comes with it. Lot of forms, don’t you think?”

  Veronica gives her a sideways look. It’s a whole-body exercise in control not to spit out a withering “you don’t say”. Biting her tongue, she fishes around for a diplomatic answer as they approach the coffee shop with its over-roasted beans and under-filled cups.

  “Actually,” Veronica says, because decent coffee is a human right, especially for doctors, “come with me.”

  “Oh?” Is all Cassie can say, before falling into step as they take a side door out of the long corridor, and she keeps pace easily in her rather new-looking running shoes—the better for vaulting over counters or whatever they’ve been doing in Trauma today.

  In her heels, Veronica regrets the shortcut across the little quad, but the ground is hard enough that she doesn’t sink too badly.

  “We use the hospital coffee shop as a sort of fork in the road, you see,” Veronica explains as they duck between two huge buildings out onto the street. “If you’re genuinely knackered, it’ll do. Not great, but drinkable. Now on a better day, when you’ve still got some juice in the tank, you use it as your landmark to cut through here and be good to yourself.”

  She sounds like a fucking travel agent. Veronica doesn’t want to speculate as to why she can’t just act normally around this woman. It’s like being a junior again, trying too hard to make an impression.

  Cassie gives the Greek café an approving nod. The scent of well-roasted coffee envelops them as another customer darts out of the door with a cardboard carrier of steaming cups. Cassie seems to think that’s encouragement enough and barges right ahead to the counter.

  “I haven’t eaten,” she explains when Veronica appears at her elbow. “Not quite used to having this many options all in one place. Anything you recommend?”

  Veronica smiles at Eleni behind the counter. “I’ll have my usual double shot latte, and Ms Taylor here will have my lunch special.”

  “To go?”

  “Oh, I’ve got time to eat here,” Cassie says. “Just some water for me, for now.”

  “You’re not one of those people who actually gets their two litres a day, are you?” Veronica can’t help teasing.

  “Force of habit.” Cassie waves it off, taking a seat at one of the handful of small tables in the place, right in the corner of the two huge windows. Veronica has little choice but to follow. “You get good about hydrating when it’s not exactly reliable.”

  “You were in Afghanistan, then? I mean, sorry,” Veronica catches herself. “Wading in like this is the salon and I’m asking where you’re going on holiday. I appreciate it may not be something a person wants to discuss over lunch. Or even any of my business.”

  “I was in Helmand for a while, yes. Basra before that. Where there’s action they need medics, so… What about you? I mean, you were a steady pair of hands during that emergency crike the other day, but how come every question I have at St Sophia’s, I’m always referred to the all-knowing Ms Mallick?”

  Veronica pretends the compliment isn’t affecting her. It might be nice if her colleagues ever spoke to her that way, but that’s just not how the world works. She knows soon enough when they’re blaming her for something, at least. “They just know I rarely leave a job undone, that’s all.”

  “Not a bad quality in a surgeon.” Cassie pauses to thank Eleni for bringing over a plate of moussaka. “Oh, I’ll let you order for me again. This looks delicious.”

  Veronica feels a little regretful she didn’t order some for herself, and they’re hardly at the two-forks-one-plate level of acquaintance. “Better than camp rations, I’ll assume? Less sand?”

  Cassie takes her first bite, eyes fluttering closed in something that looks a lot like bliss. “Just a bit.”

  “It’s funny, I only hear the Scouse come through very faintly.” Veronica winces when it sounds like an accusation. There’s that blush on Cassie again.

  “I’ve been away from Liverpool a long time. We can’t all be posh, you know.”

  “Hardly,” Veronica dismisses with a sip of her still-too-hot coffee. “Just Cambridge rubbing off. Always been a bit of a sponge that way. Comes from not wanting to sound like my parents. You know how it is.” A shrug—the end of the topic, hopefully.

  “Not to downplay…anything…but isn’t medicine the one place where an Indian background is sort of, y’know…”

  “Wow, deftly handled, Major. You should be in HR with that tactful discussion of race. I get a fair amount of people assuming my surname is Patel, if that’s what you mean. Otherwise? You’re right. We’re sort of expected to be doctors, especially second generation like me. Ironically, my dad is the one who didn’t want me to pursue medicine.”

  “Really? Old-fashioned sort?” There’s no malice behind Cassie’s question, more a quiet sort of sympathy if Veronica’s reading it right.

  “No, he thought it was too strict, too much like selling out. He was a frustrated novelist, for the most part. Always thought he might be the next Salman Rushdie, but then without my mum there was so much to do… Still, he said any daughter of his should have the soul of a poet. We’re still waiting for evidence of my first sonnet, unfortunately.”

  “You lost your mother young?”

  “Young enough,” Veronica says, though this isn’t a part of her history she prefers to share. “She passed when I was seven.”

  “Sorry. You’d think I’d be better about that, since I was twelve when I lost mine. Didn’t have a dad around to disapprove of me, though.”

  Veronica lets that rest for a moment, watching Cassie stab at the side salad with her fork. She’s already shared more than she usually would, so asking Cassie the same in return is a commitment of sorts. It’s much harder to ignore someone when you know them as a person. “You live nearby?”

  “Not yet,” Cassie says with a more pronounced frown than earlier. “You read about London and housing in the paper, of course, but it’s horrendous out there. Still, even a Dickensian hovel would be an upgrade on commuting for over an hour each way from Swindon.”

  “Yikes, yes,” Veronica agrees. “Why there?”

  “My great-uncle’s place. My inheritance, I suppose. He took me in after my mum… He’s the reason I went into the Forces. When he finally shuffled off at nin
ety, I thought it might be time for me to try the real world.”

  “Regretting it yet?”

  “Things blow up less, that’s a plus. Otherwise? Jury’s still out.”

  Veronica’s just about to make a terribly witty remark about judge, jury, and executioner when the café door jingles open. Normally that wouldn’t be enough to distract her, but she’s always been a little spooky when it comes to sensing her son’s presence.

  “Daniel?”

  “A’ight, Mum?”

  “I hope you’ve got a very good reason for why you’re not still in double something or other. I want to say Maths, but I hear it’s French you’ve been skipping lately.”

  “Yeah, merci,” he cracks, sitting his gangly frame in the empty chair next to her. “Can I get something to eat?”

  “Are you coming to mine for dinner?” Veronica asks. “Only I haven’t seen you in two weeks, so a little notice would be nice. And if you are, you’re not spoiling your dinner, so get your eyes off that display case.”

  He rolls his eyes at her, turning his attention to Cassie. “You new?”

  She shrugs at him, eyes shrewd. “Might be.”

  “Daniel, behave. This is Major Taylor, and she’s running the Trauma service at St Soph’s.”

  “Major?” He lights up like a skinny Christmas tree. “No way, you’re army? No, wait, when did they let girls in the Marines?”

  “How do you know I’m not navy? Or RAF?” Cassie questions him, quickly scooping up the rest of her side salad, watching him the whole time.

  His hair is getting too damn long, Veronica notes with a frown. He gets the glossy dark hair from her, and though a donor makes up the rest of his DNA, Veronica could swear she sees a hint of Angela in his big brown eyes and plump lips. Maybe every parent assumes their own child to be the most gorgeous of his peers, but Veronica would swear it under oath. It’s been the case ever since he was toddling. She never understood why Angela didn’t like to focus on compliments about his appearance. Then again, not understanding things like that is part of why they’re not together anymore.